William Roberts v. L. Land Bicknell

Citation: Not availableDocket: W2000-02514-COA-R3-CV

Court: Court of Appeals of Tennessee; June 19, 2001; Tennessee; State Appellate Court

Original Court Document: View Document

SummaryOriginalCytator Case TreatmentBackward CitatorAnalysis

EnglishEspañolSimplified EnglishEspañol Fácil

In this medical malpractice case, William H. Roberts, M.D. and his wife sued S. Lane Bicknell, M.D., Harvey C. Harmon, M.D., Roy Appleton, M.D., and The Jackson Clinic Professional Association for damages due to alleged negligence, failure to meet the standard of care, and lack of informed consent related to Roberts' prostate cancer treatment via cryoablation. The trial court granted partial summary judgment to the defendants for claims arising more than one year before the lawsuit was filed, citing the statute of limitations, and subsequently granted summary judgment on the remaining claims. The plaintiffs appealed, but the court affirmed the trial court's decision.

Roberts was diagnosed with prostate cancer in December 1994 and opted for cryosurgery after being informed by Dr. Bicknell that it was a suitable treatment option. Although Bicknell noted the procedure's experimental status and potential insurance coverage issues, Roberts relied on Bicknell's recommendation without conducting his own research. Following the procedure performed on December 27, 1994, Roberts experienced severe complications, including rectal damage and abnormal bodily functions, which led to further medical intervention. The defendants denied the allegations and asserted the statute of limitations as a defense.

Dr. Roberts was hospitalized twice in 1995 due to complications from a urethrorectal fistula, which led to a recommendation for a temporary colostomy by Dr. Harmon, approved by Drs. Bicknell and Appleton. Despite assurances that the fistula would heal without surgery, complications arose, including recurrent infections and a deep vein thrombosis. During a June hospital visit, Dr. Harmon suggested reversing the colostomy, but Dr. Roberts expressed a lack of confidence in the urology department and requested a different physician if the fistula had not healed. Nevertheless, Dr. Harmon proceeded with surgery on June 23, 1995, which resulted in the re-emergence of fecal matter in urine and the need for an emergency colostomy. Dr. Roberts was later transferred to Vanderbilt University Hospital, where a surgical repair of the fistula was successfully performed, followed by a reversal of the second colostomy and removal of part of his colon.

On April 22, 1996, Dr. Roberts and his wife filed a negligence lawsuit against the involved doctors and The Jackson Clinic. The trial court later granted a protective order preventing access to certain privileged documents and ruled that the statute of limitations barred claims prior to April 22, 1995. A motion for summary judgment was granted in favor of the defendants, concluding that the plaintiff's expert witness lacked the competence to testify on the standard of care, leading to the dismissal of all remaining claims. The trial court's decisions are being challenged on three grounds: the statute of limitations ruling, the exclusion of the expert witness, and the protective order regarding document discovery. Summary judgment is granted when there are no genuine material facts in dispute and the moving party is entitled to judgment as a matter of law, placing the burden on the movant to demonstrate this lack of genuine issues.

On a motion for summary judgment, the court must favor the nonmoving party by viewing evidence in the strongest legitimate light, allowing reasonable inferences, and disregarding countervailing evidence. According to Byrd v. Hall, the moving party must first show no genuine issue of material fact; then, the nonmoving party must present affidavits or discovery materials that demonstrate a genuine dispute. Under Rule 56.05 (now 56.06), the nonmoving party cannot rely solely on pleadings but must specify facts indicating a genuine issue for trial. Summary judgment is appropriate only when the facts and legal conclusions support a single conclusion. There is no presumption of correctness in a trial court's summary judgment grant, which is reviewed de novo.

The plaintiff's primary issue is whether the trial court erred in granting summary judgment for claims prior to April 22, 1995. Dr. Roberts filed his suit on April 22, 1996, challenging claims against Drs. Bicknell and Appleton for lack of informed consent and negligence, both governed by a one-year statute of limitations under T.C.A. 29-26-116. This statute states that limitations begin when the patient discovers or should have discovered the breach of duty causing injury and the identity of the defendant. The court clarified that a plaintiff cannot delay filing until all effects of the injury are known and that knowledge of facts sufficient to put a reasonable person on notice of an injury is essential for the statute of limitations to commence. This includes awareness of both the injury and its wrongful cause.

The Plaintiff argues that the statute of limitations for Dr. Roberts' claim should commence only when he became aware of the tortious nature of his injuries, citing Defendants' admission that he was not informed of the potential for medical negligence resulting in a fistula. The record indicates that by January 9, 1995, Dr. Roberts experienced severe symptoms, including air and feces being expelled inappropriately, and was aware that these complications had not been disclosed to him prior to surgery. Although he acknowledged his lack of direct experience with such a fistula, he understood it to signify a serious medical issue. This awareness, coupled with the fact that he had not been informed of possible complications, suggests he was put on inquiry about potential wrongful conduct.

The Plaintiff also contends that the statute of limitations should not begin until the doctor-patient relationship ended, as Defendants allegedly assured him the fistula would heal on its own. However, the court finds this argument unpersuasive, asserting that the claim of lack of informed consent arises once a patient realizes they were not adequately warned of risks. Dr. Roberts’ discovery of his medical condition constituted knowledge of a complication, making ongoing reassurances irrelevant to the discovery date.

Furthermore, the Tennessee Supreme Court has dismissed the "continuing medical treatment doctrine," which previously allowed for the tolling of the statute of limitations during ongoing treatment. As established in Stanbury v. Bacardi, if a patient is aware of their injury before treatment concludes, the statute of limitations is not tolled. The court concludes that Dr. Roberts had sufficient awareness of his condition well before filing his suit, affirming the trial court’s grant of partial summary judgment to the Defendants. The court also reviews whether summary judgment was properly granted to Drs. Bicknell, Appleton, and Harmon on remaining claims, referencing T.C.A. 29-26-115 regarding the burden of proof in malpractice actions.

The excerpt outlines the legal standards and requirements for establishing negligence in a medical malpractice case under Tennessee law. Key points include: 

1. To prove medical negligence, the plaintiff must demonstrate that the defendant's actions fell below the recognized standard of acceptable professional practice in the relevant community at the time the alleged injury occurred. 
2. The plaintiff must also show that the defendant acted with less than ordinary and reasonable care and that this negligence was the proximate cause of the plaintiff's injuries.
3. Only licensed professionals from Tennessee or contiguous states who practiced in the relevant specialty within the year preceding the incident are qualified to testify as expert witnesses.
4. Drs. Bicknell and Appleton provided affidavits confirming their adherence to the standard of care for urologists in Jackson, Tennessee. The plaintiff did not produce expert testimony challenging their standards or actions, leading to the trial court granting summary judgment in their favor.
5. The plaintiff’s claims against Dr. Harmon included specific allegations of negligence regarding the treatment of Dr. Roberts, such as failing to diagnose and treat a urethrorectal fistula appropriately.
6. The plaintiff's only expert witness, Dr. David Armstrong, was deemed incompetent to testify about local standards due to a lack of knowledge regarding the standard of care in Jackson.
7. The trial court's determination that Dr. Armstrong did not meet the qualifications under the "locality rule" was upheld, reinforcing that the burden of proof for establishing negligence rests with the plaintiff, who must provide expert testimony that aligns with statutory requirements.

This summary captures the essential elements of the original document, detailing the legal standards, case specifics, and court rulings relevant to the malpractice claims.

The admissibility of Dr. Armstrong's expert testimony hinges on whether it is grounded in "trustworthy facts or data" relevant to the standard of care for surgeons in Jackson, Tennessee, circa 1995. The trial court possesses broad discretion in assessing the qualifications and relevance of expert testimony, and its decisions will only be overturned upon a clear showing of abuse of discretion. Despite Dr. Armstrong’s affidavit asserting familiarity with the local standard of care, his deposition revealed a lack of knowledge about Jackson, including its size, hospitals, and local medical practitioners. This lack of community-specific knowledge is critical under Tennessee law, which mandates that an expert must understand the medical practices relevant to the locality in question. The court emphasized that comparisons between communities necessitate knowledge of local characteristics, including the existence of teaching hospitals. The plaintiff's argument for a shift from a locality standard to a national standard of care was rejected, referencing a precedent in which a similar expert was deemed inadmissible for relying on a national standard. Additionally, the plaintiff posits that conflicting testimonies from Dr. Joseph Smith and Dr. Guy Voeller create a factual dispute, but this does not negate the necessity for Dr. Armstrong's testimony to meet the locality requirement.

Dr. Smith was not disclosed by the Plaintiff as an expert witness against Dr. Harmon, and his testimony indicated he lacked knowledge of the standard of care for surgeons like Dr. Harmon in the Jackson area. Dr. Voeller concluded, from the record, that Dr. Harmon adhered to the standard of care. Dr. Voeller's deposition, taken under Tenn. R.Civ. P. 26.02 (4), is admissible only for impeachment, per Tenn. R.Civ. P. 32.01 (1). The evidence required for summary judgment must be admissible, as stated in Tenn. R. Civ. P. 56.06. The court found no genuine issue of material fact regarding the claims against Dr. Harmon, leading to the correct granting of summary judgment in his favor. The Jackson Clinic, being sued solely under respondeat superior, also received summary judgment correctly. A protective order concerning records from Jackson Madison County General Hospital related to a cryoablation procedure was denied, as the claims were barred by the statute of limitations, rendering the records irrelevant. Consequently, the trial court's summary judgment for the defendants is affirmed, and the case is remanded for further proceedings, with costs assessed against the appellant, Rosemary Roberts.